An investigation of type 2 diabetes self-management in Taiwan

In Taiwan, as in other countries, type 2 diabetes is a major public health problem. Taiwanese nurses are being called upon to play an increasingly large role in diabetes care, but little is known about the factors that contribute to good or poor diabetes self-management in the Taiwanese context. This study is an exploratory investigation of Taiwanese women’s experiences of living with type 2 diabetes. Adopting an open-ended qualitative approach, the research aimed to discern personal characteristics, strategies, socio-cultural and health system factors that affected women’s ability to manage their condition effectively. Thirty-eight women were interviewed. These included twenty women who were nominated by health professionals as being effective at diabetes self-management and eithteen who were considered to have difficulties, in controlling their HbA1c. Five senior diabetes nurses were also interviewed. Data was analysed thematically. The study found that for many women, their diabetes diagnosis was marked by profound shock and change in their sense of self. Learning to live with diabetes was an ongoing ‘journey’ in which women engaged in a range of strategies to acquire information and support, to gain a sense of control over their condition and to find a health care provider they could trust. The findings challenge the prevailing medical model that defines ‘successful’ self-management on the basis of clinical outcomes alone. Rather, self-management was found to be highly contingent upon individual life circumstances. From women’s own perspectives, successful self-management involved coping with a context of severe social stigma and juggling their own self-care alongside maintenance of multiple social gender roles and financial responsibilities, often in the face of social or economic difficulties. The research points to a need for health professionals to adopt a non-judgemental, individualised and empowering philosophy in their approach to diabetes care whereby education and treatment is tailored to the specific and complex needs of individual patients